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Background: Glycoprotein (GP) IIb/IIIa antagonists are used routinely for the treatment of acute coronary syndrome and to prevent thromboses during percutaneous coronary interventions. It is not uncommon for patients who initially require a GP IIb/IIIa inhibitor to eventually receive a surgical intervention. Objective: To compare the difference in bleeding indices in patients who undergo coronary artery bypass grafting (CABG) after receiving either eptifibatide or abciximab. Methods: A retrospective chart review was completed on all adults who received abciximab or eptifibatide within 24 hours prior to undergoing CABG. Patients were excluded if they had received a dose of warfarin within 96 hours prior to the procedure or if they had an incomplete medical record, an off-pump procedure, a known hypercoagulable disorder, or hemophilia. A total of 54 patients were included and preoperative data, including doses of anticoagulant and antiplatelet agents, were recorded. Intraoperative and postoperative data collected for analysis included hemoglobin level, chest tube output, and the amount of blood products transfused for 24 hours postprocedure. Results: There was a statistically significant difference between the eptifibatide and abciximab groups in the amount of fresh frozen plasma (mean ± SD, 21 ± 31 vs 187 ± 125 mL, respectively; p < 0.05) and platelets (212 ± 81 vs 433 ± 118 mL, respectively; p < 0.01) transfused during the intraoperative period. However, when the total amount of blood products transfused intraoperatively (769 ± 243 vs 1395 ± 316 mL, respectively; p = 0.47) was evaluated, no significant difference was detected. Likewise, markers for bleeding that were collected during the 24-hour postoperative window (immediate and 24-h postoperative hemoglobin and total 24-h chest tube output) were not significantly different. Conclusions: Although there is an increased risk of bleeding when abciximab or eptifibatide is administered prior to CABG, no significant difference in the total amount of blood products used was detected between the 2 agents in this study.

Background: The potential for medication errors in a hospital setting has led to a change from daily order writing to scheduled dosing. It has also been hypothesized that scheduled dosing may decrease the pharmacists' workload in a community teaching hospital. Objective: To evaluate the impact that scheduled warfarin dosing would have on patient safety for a pharmacist-run anticoagulation service. Methods: Two methods for managing warfarin in a pharmacist-run anticoagulation service were compared. A retrospective chart review was conducted on a random sample of 80 inpatients who received warfarin either from January 2006 through December 2006 (control/ daily dosing group) or from January 2007 through March 2007 (scheduled dosing group). Patients not managed by pharmacists or with a target international normalized ratio (INR) range other than 2 to 3 were excluded. Results: A total of 35 patients met inclusion criteria; 20 patients were in the daily order (control) group and 15 were in the scheduled dosing group. A total of 7 doses were omitted in the daily dosing group, compared with none in the scheduled dosing group. Of the 7, 4 were omissions in administration and 3 were order omissions. In the control group, the dose was changed 47 times (36%) compared with 23 times (28%) in the scheduled dosing group. In the daily dosing group, 28 (22%) INRs were within the therapeutic range and 97 (78%) were in the nontherapeutic range. In the scheduled dosing group, 24 (25%) INRs were within the therapeutic range and 72 (75%) were in the nontherapeutic range. Conclusions: Scheduled dosing eliminated omission-type medication errors and was more efficient than daily dosing. The process change decreased pharmacist workload without having a negative impact on patient care.

Introduction: Community-based postgraduate programs, including residencies and fellowships, have grown at a slower rate than other postgraduate programs in pharmacy. Faculty influence is cited as a significant reason why students choose to pursue postgraduate training (PGT) and thought to be a reason why students may or may not pursue community pharmacy PGT. Greater faculty encouragement of community PGT may help advance community pharmacy forward. Objective: To determine the knowledge, attitudes, and practices that pharmacy faculty have regarding community-based pharmacy postgraduate training, including community-based pharmacy residencies (CBPRs), community pharmacy fellowships (CPFs), and independent pharmacy ownership residencies (IPORs). Methods: A web-based survey was distributed to faculty members at 50 pharmacy schools, those with the 25 highest and 25 lowest 2019 residency match rates. The data collection tool was a “Knowledge, Attitudes, and Practices” (KAP) survey administered through Qualtrics and distributed by email. Descriptive statistics were used to identify gaps in faculty knowledge of PGT and trends in their attitudes and current practices. χ2 tests were used to determine differences between the two cohorts. Results: There were no significant differences between the responses of high and low residency match performers. Overall, faculty are aware of CBPRs (95%), somewhat aware of CPFs (59%), and less aware of IPORs (38%). Among those aware, the majority were unable to accurately identify the program standards of residency or fellowship. Faculty members encourage and help students pursue PGT to various levels and most seek information about PGT from national organizations and colleagues. Conclusion: This study highlights that faculty are aware of PGT opportunities in community pharmacy; however, gaps were identified in knowledge about activities and the value of community PGT. This demonstrates the need to engage faculty about the changing practice landscape of community pharmacy, the impact of faculty mentoring on students pursuing community PGT, and the importance of community PGT to advance the profession.

Reproduction in whole or in part without permission is prohibited. The production of a beta-lactamase—a type of bacterial enzyme—is the most common mechanism of resistance to beta-lactam antibiotics among gram-negative bacteria. Extended-spectrum beta-lactamases (ESBLs) hydrolyze most penicillins, extended-spectrum cephalosporins, and aztreonam. Infections due to ESBL-producing organisms are associated with increased mortality. Once an ESBL is detected, appropriate treatment is important in order to ensure optimal patient outcomes. Infections caused by ESBLs are challenging to treat for various reasons, including difficulty in detecting ESBL-producing organisms as well as mixed data on how to best treat these infections. The increasing worldwide prevalence of infections caused by ESBL-producing organisms highlights the importance of antimicrobial-stewardship programs to promote appropriate use of antibiotics and lessen the risk of subsequent development of resistance.

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